=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750848347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DREAMERS VISION ACADEMY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2019
-----------------------------------------------------
Last Update Date | 03/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4449 LINCREST DR S
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32208-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-803-1046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4449 LINCREST DR S
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32208-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-803-1046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | MRS. VIRGINIA BAKER -WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-803-1046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------